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The initial diagnostic workup for ulcerative colitis consists of a complete history and physical examination, assessment of signs and symptoms, laboratory tests and endoscopy. [69] Severe UC can exhibit high erythrocyte sedimentation rate (ESR), decreased albumin (a protein produced by the liver), and various changes in electrolytes.
Diarrhea, weight loss, flatulence, abdominal bloating, abdominal cramps, and pain may be present. Although diarrhea is a common complaint, the character and frequency of stools may vary considerably ranging from over 10 watery stools per day to less than one voluminous putty-like stool, the latter causing some patients to complain of constipation.
Most people with previous ileal resection and chronic diarrhea will have abnormal SeHCAT tests and can benefit from bile acid sequestrants. [4] People with primary bile acid diarrhea are frequently misdiagnosed as having irritable bowel syndrome. [17] When SeHCAT testing is performed, the diagnosis of primary bile acid diarrhea is commonly made.
Stool osmotic gap is a measurement of the difference in solute types between serum and feces, used to distinguish among different causes of diarrhea. Feces is normally in osmotic equilibrium with blood serum, which the human body maintains between 290–300 mOsm/kg. [ 1 ]
In chronic diarrhea there is no evidence of blood in the stool and there is no sign of infection. The condition may be related to irritable bowel syndrome. [1] There are various tests that can be performed to rule out other causes of diarrhea that don't fall under the chronic criteria, including blood test, colonoscopy, and even genetic testing.
The main symptom is persistent non-bloody watery diarrhea, which may be profuse. People may also experience abdominal pain, fecal incontinence, and unintentional weight loss. [1] Microscopic colitis is the diagnosis in around 10% of cases investigated for chronic non-bloody diarrhea. [2]
The diagnosis is made through several laboratory tests and imaging studies: [13] Secretin stimulation test, which measures evoked gastrin levels. Note that the mechanism underlying this test is in contrast to the normal physiologic mechanism whereby secretin inhibits gastrin release from G cells.
In the simplest form of the fecal fat test, a random fecal specimen is submitted to the hospital laboratory and examined under a microscope after staining with a Sudan III or Sudan IV dye ("Sudan staining"). Visible amounts of fat indicate some degree of fat malabsorption.
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